Trends in PCI Appropriateness

Jul 01, 2015

ACC News Story

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Journal Wrap | The use of percutaneous coronary intervention (PCI) procedures for elective indications has decreased over time, with concurrent improvements in PCI appropriateness, according to results of a new study published May 28 in Circulation.

Study investigators applied appropriate use criteria (AUC) to determine the appropriateness of all 51,872 PCIs performed in Washington State from 2010 through 2013. They evaluated the number of PCIs performed from 2006 through 2013 to provide a comparator period that preceded statewide appropriateness assessment beginning in 2010.

Results showed a decrease of 6.8% in the overall number of PCIs, with a 43% decline in the number of PCIs for elective indications (3,818 PCIs in 2010 to 2,193 in 2013). The decline in use of elective PCIs was significantly larger following the onset of the statewide PCI appropriateness assessment in 2010 (p = 0.03). Study investigators also noted that the proportion of elective PCIs classified as appropriate increased from 26% in 2010 to 38% in 2013, while the proportion of inappropriate PCIs decreased from 16% to 13% (p < 0.001 for trends). In particular, significant improvements in the proportion of inappropriate PCIs were limited to the tertile of hospitals with the largest decline in PCI classified as inappropriate (25% in 2010 to 12% in 2013; p = 0.03).

In an ACC Journal Scan, Debabrata Mukherjee, MD, noted that improvements in appropriate use of PCI were not uniform across hospitals, with a small number of hospitals already having high-quality patient selection processes. “There appears to be an opportunity to identify best practices in patient assessment and selection processes through targeted investigation of these high-performing hospitals, and to validate the importance of patient selection processes identified at these hospitals with improvements in PCI appropriateness,” he said.